Early Detection of Lower Adherence to Long-Term E-Diary Recording: A Checkpoint to Target Early Educational Intervention in Seasonal Allergic Rhinitis

Abstract

Background: Digital symptom monitoring via e-Diary apps can support the diagnosis and management of chronic diseases with trigger-induced exacerbations such as pollen allergies. Attrition is a major challenge for continuous e-Diary usage with an unsupervised approach. Objective: To investigate adherence to e-Diary reporting, its early determinants and predictors in a blended care setting among pollen allergic patients with heterogeneous cultural backgrounds. Methods: The @IT.2020 observational multicenter study recruited patients with diagnosed seasonal allergic rhinitis from seven Southern European/Mediterranean countries. Baseline characteristics were investigated through questionnaires, skin prick tests and serum specific IgE measurements. The study doctors asked patients to record their allergy symptoms via e-Diary (AllergyMonitor, TPS) daily during the clinically relevant season of pollination and increased mould concentrations. Results: Among 815 patients (467 adults, 348 children), the average prescribed e-Diary recording period was 106 (SD 47.1) days, with an average completion rate of 75.2% (SD 21.2%). Children (>= 10 years) filled 73.8% (95% CI 68.1-79.4) of prescribed days without parental support. We identified a stable 'higher' and a more variable 'lower' adherence cluster. Adherence was weakly associated with disease severity, but not with age, gender, country, education or digital literacy. Short-term (first 3 weeks) adherence was strongly associated with long-term adherence (partial R-2 = 0.387, p < 0.001), with 87.6% of lower adherent patients remaining poorly adherent beyond 3 weeks. Conclusion: In a blended care setting, adherence to e-Diary compilation among pollen allergic patients is high, irrespective of age and cultural background. Early identification of lower adherence is possible and might inform early interventions to improve patient adherence.